NHS faces biggest shake-up in deades

12th July 2010

This afternoon's white paper will set out radical measures to overhaul health service

The NHS faces its biggest shake-up for decades as ministers prepare to give family doctors control over £70bn of healthcare budget, and to roll out reforms that could give the private sector a greater role in health services.

The coalition had previously sought to reassure health workers tired of years of almost constant reform that they would avoid "massive structural reorganisation". However, a white paper published this afternoon will set out a wide range of radical measures, including proposals to:

• Allow GPs to spend billions of pounds of taxpayers' money on behalf of patients through the creation of 500 GP consortia across England.

• Allow NHS foundation hospital trusts freedom to leave the state sector, and give them university-style powers to to borrow money and hire and fire staff.

• Require doctors to keep data on their own performance and publish detailed evidence of hospital mortality rates.

The white paper plans could put the coalition on a collision course with medical unions and hospital staff.

The health secretary, Andrew Lansley, is expected to claim that the reforms will drive up the quality of health services and improve survival rates in areas such as cancer and strokes.

He said: "Over nine years ago, Tony Blair committed the government to matching European levels of health spending. Today, that pledge has been delivered. But do the results for patients match the increase in spending?

"That is what the previous government's regime of top-down process targets and central bureaucratic control of the NHS was supposed to ensure. However, many of our health outcomes – including stroke and cancer survival rates – lag behind our European counterparts. We will get rid of the top-down process targets which get in the way, improving patient care. Only by focusing on results for patients will survival rates improve to the level that they should be."

But the shadow health secretary, Andy Burnham, said the plans made him "want to weep". After all Labour's painstaking work to put together the complicated jigsaw of an outstanding health service, "Lansley is about to pick up that jigsaw and throw it all up in the air".

Lansley said yesterday that the changes would give patients greater freedom, without choices being taken away by "unaccountable bureaucracy".

He said: "The principles are very straightforward. First, patients should exercise more control over their healthcare. Decisions should only be made about us, with us.

"The second principle is the people we trust: we trust the doctors and nurses, GPs, hospital consultants, hospital nurses. We trust them in matters of life and death. Shouldn't we actually expect that at the same time they have responsibility for making decisions about our care?

"The third thing is, let's get rid of this tick-box target culture and the bureaucracy that goes with it. Let's focus on the outcomes."

The health secretary indicated that private health providers would have a greater role

in providing NHS services.

"We are going to make it clear that independent-sector providers can offer services to the NHS if they provide the high-quality care we are looking for, and they can do it within NHS prices," he said.

The chief executive of health thinktank the King's Fund, Professor Chris Ham, told the BBC Radio 4 Today programme: "GPs know their patients and their needs very well. They are therefore well-positioned to take decisions on the use of resources and improve patient care and patient outcomes. The risk, though, is that not all GPs have the motivation to do so. Many don't have the skills either.

"To implement this across the whole of England without some degree of testing and piloting could be a risky thing for the government to do."